Roundup Research Links Asthma in Rural Teens to Risk of Being Bullied

Rural teens with asthma are more likely than those without the respiratory condition to be bullied, according to new research from Columbia Nursing. Having persistent asthma symptoms further increases teens’ risk of being bullied. The findings underscore the need for schools to promote acceptance of all students and for health care providers to offer proper asthma management education to their teenage patients, reported senior author Jean-Marie Bruzzese, PhD, and her colleagues in the January online issue of the Journal of Asthma. “Rural students with asthma, with or without diagnosis, could benefit from school-based interventions that reduce victimization based on this medical condition,” the researchers wrote.

Asthma narrows the airways, making breathing difficult and triggering repeated episodes of wheezing, breathlessness, chest tightness, and coughing. It affects about 5.1 million children younger than 18 years old and disproportionately impacts Black children, who are nearly three times as likely as white children to have the condition.

Bullying is also prevalent among children in the United States; one in five report being bullied in school.

To fill gaps in the literature regarding the relationship between asthma and bullying among rural U.S. adolescents, Bruzzese and her colleagues surveyed 1,905 rural high school students between age 12 and 19; the participants’ mean age was 15.7 years. “We targeted rural kids because they’re ignored in asthma research,” says Bruzzese, a professor of applied developmental psychology.

About half of the students in the study sample were female, half selfidentified as Black/African American, and 15 percent had been diagnosed with asthma in the preceding year. More than half had no formal asthma diagnosis but had experienced asthma-like symptoms in the preceding year, while one-third did not have asthma or symptoms of the condition. Among those with current asthma, 59 percent had persistent symptoms. Being a victim of bullying in the preceding 12 months was common across all the adolescents. About one-quarter reported having been bullied for reasons that included weight or other health problems, race, or ethnicity. Those with current asthma were more likely than those with no asthma to report having been bullied. Those with possible undiagnosed asthma had 2.42 times the likelihood of being bullied as those with no asthma. “Having a diagnosis is not the driving factor of bullying,” Bruzzese says. “It’s experiencing symptoms in front of peers that is problematic.”

Anything that differentiates teenagers from their peers—whether race or ethnicity, sexual orientation or gender identity, weight, or other physical characteristics—increases their risk of being bullied, points out co-author April Ancheta, PhD ’22. “Teens with asthma have to take time away from their friends to control their symptoms,” Ancheta says. “Going to the nurse to use their inhaler or not being able to attend gym or participate in sports draws attention to their difference.”

Adolescents with persistent asthma symptoms—those that occur at least three times a week—had even higher odds of bullying victimization than those with intermittent asthma, Ancheta says. Adds Bruzzese, “Kids who have persistent symptoms have a greater chance of their peers observing them and thinking that they’re weak.”

Black adolescents and Hispanic adolescents, compared to White adolescents, were significantly less likely to report having been bullied, however. “Black adolescents and Hispanic adolescents were not the minority at their school, which was actually a protective factor,” Bruzzese notes.

Experiencing bullying damages adolescents’ self-esteem and other aspects of their psychosocial development. It is linked to wide-ranging psychological and social health effects, including depression and anxiety, social isolation, sleep disturbance, psychosomatic symptoms, and poor school performance and attendance. “Bullying is problematic, not only at the time it’s happening but [with] ramifications in adulthood,” Ancheta says.

It is important to empower teens to manage their asthma symptoms by taking their medication regularly and avoiding environmental triggers like dust or pollen, she explains. “Taking responsibility for their asthma symptoms, especially as they transition from adolescence to adulthood, can help not only to reduce their risk for bullying victimization but also promote self-acceptance,” says Ancheta.

Meanwhile, teachers and school administrators and nurses should be aware of the increased risk of being bullied for adolescents with asthma or other chronic medical conditions, and thus the need to create inclusive environments that are accepting of all students’ abilities and conditions. “Teachers and administrators should teach kids that people sometimes pick on others because they are different, including those who have asthma,” Bruzzese says. “If kids start to understand what asthma is, then they may be less inclined to see their peers as being weak and there may be less bullying.”